Bridgwater Satellite Dialysis Unit

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This is the first assessment for this service. This key question has been rated good.

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

We have not awarded this service a score for Well-led.

Find out about when we will not publish a key question score and what we look at when we assess Well-led.

We scored the service as 3. The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. Fresenius had core values which included ‘we care, we connect, we commit’. We saw appraisal discussions produced objectives based on the overall strategy.

Staff could explain how they were working to deliver high quality care. There was an open and supportive culture at the unit. Staff we spoke with said the teams worked well together.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The clinic manager was visible and approachable for patients and staff. They had been at the unit for 5 years at the time of inspection and had a good understanding of the service they managed. Staff spoke positively about the clinic manager and felt supported and able to raise any concerns.

Staff were supported to develop their skills and offered courses to progress their careers. One member of staff started working for the service as a dialysis assistant, became a registered nurse and had also completed a renal vascular access course with support from the service.

We saw action plans in relation to the staff survey results which included a check in during 1 to 1 and team meetings with staff and increasing the usage of the staff spotlight board to recognise staff achievements. During our inspection we saw an ‘outstanding contributor of the month’ board where a staff member had been named.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

There was a culture of speaking up where staff felt able to actively raise concerns. The provider had the Freedom to Speak up Guardian that allowed staff to speak up/raise concerns about anything that got in the way of patient care or affected their working life. A Freedom to Speak Up Guardian is a designated individual in an organisation who supports workers to raise concerns they may have, especially when they feel unable to do so through normal channels. The guardians act as a safe point of contact and help ensure that workers are heard, their concerns are addressed, and feedback is provided on any actions taken.

Staff we spoke with knew about the Freedom to Speak Up process and how to contact the Freedom to Speak Up Guardian. They felt they would be supported to raise concerns without fear of detriment; they had not however had to do this.

We requested the staff survey results where overall the unit scored 81%. However, we were sent the staff survey action plan which included the statement ‘staff can comfortably voice their ideas and opinions even if they are different from others’. One of the actions from this was to prepare the team meeting agenda to check any progress on outstanding recommendations. This was due to begin in March 2026. We reviewed team meeting minutes from April 2026 and this was not an agenda item.

We scored the service as 2. The evidence showed some shortfalls. The service did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Managers put in reasonable adjustments for staff members to help them carry out their role. We spoke with staff members who had their request for flexible working arrangements agreed.

Staff received training in equality, diversity and human rights.

The service did not have any defined staff network groups, such as disability, LGBT and race equality networks. We requested the Workforce Race Equality Standard (WRES) report. It is a reporting requirement for independent healthcare providers who are commissioned by NHS services to produce an annual report. The WRES reports on how organisations are addressing race equality issues in a range of staffing areas. However, we did not receive this.

We scored the service as 2. The evidence showed some shortfalls. The service did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

There was an overarching governance structure with lines of accountability through the centre, region and through to the UK section of Fresenius Medical Care. However, despite this structure, governance oversight and monitoring was not always effective at the service.

All governance meetings followed the provider’s governance principles. This resulted in a standardised agenda for all governance meetings at all levels of Fresenius Medical Care services. Records of governance meetings mostly demonstrated the quality, performance and safety of the service were monitored and reviewed. This included monitoring and review of safety incidents, risks, staffing and training. However, we reviewed minutes of meetings between November 2025 and April 2026. Minutes from the April 2026 meeting showed leaders reminded clinical staff to complete ‘safeguarding levels 1, 2 and 3’ training but this was not in line with the policy. There was no clarification regarding whether this included children’s safeguarding training.

The service undertook a programme of audit, however, audits were not always completed regularly to ensure consistent oversight and monitoring enabling the service to drive improvement when required. For example, there was no system at the time of our inspection to ensure regular oversight of medicines. During the inspection we found out of date items in the medicine cupboard which needed to be removed. At the time of our inspection, medicine management audits were completed annually. There was a medicines management audit scheduled for May 2026 (this was 1 month after our inspection). Following the inspection, the service implement monthly medicine management auditing to ensure better oversight of medicines in the service. As this had been changed after the inspection, we were unable to assess whether the changes had become embedded.

Although the unit had completed a disability access audit, there were no associated actions plans as a result of this audit where the unit had not met the Accessible Information Standard.

There was a lack of oversight at clinic level to ensure servicing of dialysis machines was timely. There were 2 dialysis machines in patient use on the unit which were out of date for their service. Although there had been limited impact on the service, there was a risk overdue servicing may compromise the safe and effective delivery of dialysis treatment and place patients at risk of avoidable harm.

However, we also saw examples where auditing had been effective to drive improvement. Audits of nursing documentation were undertaken at a minimum of every 3 months. We reviewed the audit from April 2026 which had identified some areas of a patient record had not been updated. The discussion with the member of staff was noted to remind them the importance of keeping patient records updated.

The service followed processes to gather information to gain assurance that staff were delivering safe and effective care that followed national guidance. This included infection prevention and control and records audits. The service took action from the outcome of audits to drive improvement across the service to improve safety and patient experience. For example, we saw evidence of the monthly IPC audit results between February and April 2026 were 95% and above compliant and these results had been escalated to the cleaners to improve further. Hand hygiene audits were completed monthly, and feedback was given to staff with the aim to improve practice.

There was a framework of what was discussed at bi-monthly team meetings and monthly clinical governance meetings. This meant essential information, such as learning from incidents and complaints, was shared and discussed. The service had regular meetings with partnership organisations to ensure the regular flow of information between services.

The service had a risk register, which highlighted current risks to the service and any controls to mitigate risks. There was also an emergency preparedness plan, which gave details for who to contact in the event of an emergency.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

There was regular collaboration between the unit and the NHS trust, reinforced by structured meetings, to ensure there was a regular time and space for the collaboration to occur.

Staff worked collaboratively with Fresenius Medical Care to provide support for patients wishing to go on holiday. Fresenius Medical Care had dialysis units worldwide. Staff would source and book patients into other dialysis units for holiday and ensured those units had the relevant information to enable seamless care and treatment for the patient.

The service engaged with the local patient transport company to help ensure patients that required transportation had a timely service.

The contingency planning for emergency preparedness involved nearby dialysis units and NHS trust.

Patients and staff could meet with members of the provider’s senior leadership team and commissioners to give feedback.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Staff were given protected time to carry out mandatory learning and supported to attend training which improved their competency levels.

Staff were given the time and support to develop opportunities for improvements and innovation and this led to changes in care delivery. A patient-centred assessment tool was developed within the unit to identify and record patients’ additional needs early in their treatment journey. This enabled staff to access key information easily, improve understanding of individual challenges, and deliver more consistent, holistic care. Early assessment helped ensure patients received appropriate support while enhancing staff awareness, skills, and education.